Elevance sues over Medicare Advantage star ratings

Elevance Health is the latest Medicare Advantage insurer to dispute its star ratings quality scores in court.

The health insurance company filed suit against the federal government in the U.S. District Court for the Northern District of Texas on Thursday. According to Elevance Health, the Centers for Medicare and Medicaid Services improperly assessed its quality performance, costing the insurer $375 million in bonus payments. The company won a case regarding its 2024 star ratings on different grounds, which led the agency to recalculate scores across the program.

Related: Why 3 Medicare Advantage insurers sued over star ratings

Elevance Health wants the court to order CMS to redo its ratings and to provide insurers with the data to "validate the 2025 star ratings calculations and future star ratings calculations,” according to its lawsuit. The insurer also seeks reimbursement the court deems appropriate.

“CMS’s failure to account for statistical variability and CMS’s own suppression of data necessary to replicate its calculations highlights the absurdity of purporting to calculate plaintiffs’ overall star ratings with alleged extreme precision,” the complaint says.

Elevance Health, CMS and the Health and Human Services Department did not respond to interview requests.

The lawsuits against the 2025 star ratings are piling up. UnitedHealth Group, Humana and Centene have each brought cases against CMS over their scores.

The Medicare Advantage Star Ratings program uses a five-point scale to grade insurers on 40 metrics of customer experience, health outcomes and administrative measures. CMS awards generous bonuses to insurers that score at least four stars, which they use to eliminate premiums, reduce out-of-pocket costs and offer supplemental benefits not available under fee-for-service Medicare.

For the 2025 plan year, 40% of Medicare Advantage contracts received at least four stars, down from 44% this year. Health insurers have struggled to achieve top marks since CMS implemented significant changes to how scores are appraised. The shift has rankled insurers and their investors.